Today, we discussed a HOT case of acute on chronic cough after a visit to Yuma, AZ 4 years ago associated with fevers, night sweats, 25 pound weight loss in the setting of reportedly long-standing leukopenia of uncertain etiology, found to have fever to 102, splenomegaly, multiple groundglass nodules on CT chest, scattered moderate lymphadenopathy, and pancytopenia with ANC 1100, overall concerning for possible underlying myeloproliferative disorder with infectious (fungal?) cough . Along the way, we discussed the differential for splenomegaly and neutropenia.